MEDICARE: MS. ANN MARIE GUTHERY PSY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	064049	AZ

General Provider Information

NPI Number	:	1902897168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN MARIE GUTHERY PSY NP

Provider Business Mailing Address
First Line	:	1919 E. THOMAS ROAD
Second Line	:	AMBULATORY BUILDING, 4TH FLOOR
City	:	PHOENIX
State	:	AZ
Zip	:	86018
Country	:	US
Telephone Number	:	602-933-0990
Fax Number	:	601-933-4251

Provider Business Practice Location Address
First Line	:	10000 N 31ST AVE
Second Line	:	A-105
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9582
Country	:	US
Telephone Number	:	602-843-0000
Fax Number	:	602-997-1305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	02/04/2016

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